The cost of cancer care: part I.

Progress in oncology has resulted in the rapid expansion of more effective, less toxic therapies, due to accumulating insights into cancer biology at the cellular level. However, the rising cost of cancer treatment now competes with the availability of effective therapy as a constraining element in our war on cancer. Patients are often simply unable to afford their personal financial responsibility for the cost of care. This rising cost appears to be due to replacement of less-expensive treatment with higher-cost care, longer patient survival times extending the period of active treatment, demographic changes leading to increased disease prevalence, and changes in the site of care. Oncology drug cost is escalating rapidly. Novel therapies reach patients in an increasingly haphazard payment environment, often placing cost-sharing burdens on patients that are beyond their capacity to pay. About 25% of cancer patients consume most or all of their savings in dealing with their cancer and its treatment. Patients may value treatment in a way that is different from what has been generally perceived, assigning greater importance to the chance of a large survival gain over a more predictable modest benefit.